| 1. |
- Egeh, Abdi-Aziz, et al.
(författare)
-
The views of Somali religious leaders on birth spacing : A qualitative study
- 2019
-
Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 20, s. 27-31
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundBirth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning.ObjectiveThe study aimed to investigate Somali Islamic religious leaders’ views on birth spacing.MethodQualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28–59 years and analysed through content analysis.ResultsThe main category that emerged from the analysis was that the concept “birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women’s health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited.ConclusionAccording to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word “birth spacing” is recommended to be used instead of “family planning”.
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| 2. |
- Aalto, Sanni, et al.
(författare)
-
The effect of teacher multicultural attitudes on self-efficacy and wellbeing at work
- 2024
-
Ingår i: Social Psychology of Education. - : Springer. - 1381-2890 .- 1573-1928.
-
Tidskriftsartikel (refereegranskat)abstract
- Teachers are pivotal in creating safe and efficacious learning environments for ethnic minority students. Research suggests that teachers' multicultural attitudes, self-efficacy, and wellbeing at work may all play important roles in this endeavor. Using survey data on 433 teachers in Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom, the present study used structural equation models to analyze the paths between teachers' multicultural attitudes and work-related wellbeing (work dedication and exhaustion), and whether self-efficacy mediates these paths. We further investigated how these associations differ between teachers of reception classes for migrant and refugee students versus teachers of multi-ethnic mainstream classes. The results show that positive multicultural attitudes were directly associated with high level of work dedication, but not with work exhaustion. Self-efficacy mediated the association between multicultural attitudes and work-related wellbeing, indicated by both higher work dedication and lower work exhaustion. Concerning the role of teacher's class type, self-efficacy mediated the association between positive multicultural attitudes and work dedication for both types of teachers, whereas the mediation to low work exhaustion was only evident in mainstream class teachers. To conclude, teachers' multicultural attitudes and work-related wellbeing are mediated by self-efficacy and this important link should be acknowledged when designing professional development programs in order to create supportive and competent learning environments for all students.
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| 3. |
- Abshir, Juweria N L, et al.
(författare)
-
Parental burnout among Somali mothers : Associations with mental health, perceived social support, and sociodemographic factors
- 2023
-
Ingår i: PLOS Global Public Health. - 2767-3375. ; 3:10
-
Tidskriftsartikel (refereegranskat)abstract
- Parenthood can be defined by the contradiction that it is one of the most satisfying yet stressful experiences in life. Many parents experience stress during parenthood, and some to the extent that they display symptoms of parental burnout. Nevertheless, research on parental burnout is scant and many studies have only examined the condition in Western settings. The aim of this study was to examine parental burnout among Somali mothers in Mogadishu, Somalia, and its association with certain psychological, psychosocial, and sociodemographic factors. In this cross-sectional study, questionnaire data were collected through the measurements Parental Burnout Assessment and Patient Health Questionnaire 9, as well as through social and demographic questions. A total of 882 Somali mothers in Mogadishu participated. The analysis methods used were univariate, bivariate, and multiple linear regression analysis. The results revealed that the mean parental burnout score was low in the sample. Additionally, a significant association was found between higher levels of parental burnout and higher levels of depression, perceived lack of social support, being unmarried, having a low monthly household income, and when the youngest child was of school-age.
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| 4. |
- Baghdasaryan, Zara, et al.
(författare)
-
‘Let us understand each other and work together in the child’s best interest’ – Exploring the narratives of newly arrived refugee parents in Sweden
- 2021
-
Ingår i: International Journal of Intercultural Relations. - : Elsevier BV. - 0147-1767 .- 1873-7552. ; 81, s. 226-235
-
Tidskriftsartikel (refereegranskat)abstract
- Complex and multi-layered socio-economic and cultural challenges face refugee parents resettling in a new country. The aim of this study was to describe refugee mothers and fathers & rsquo; experiences of parenthood by lifting up their own voices, illuminating the challenges they face and laying the basis for designing interventions to provide well-informed and culturally tailored support pro-grammes for families in need.The study combined narrative research with focus group discussions with 50 refugee mothers and fathers in Sweden. Data were analysed inductively using thematic analysis. The main theme identified: Navigating the changing landscape of parenthood, captured refugee parents & rsquo; experiences of navigating their parenthood through the new socio-political, cultural, and economic setting in Sweden.The study results demonstrated how acculturation challenges undermined the role of parents, threatened the family cohesion and led to alienation of children from their parents. Despite the plethora of challenges faced by families, parents struggling to navigate two differing cultural paradigms, envisioned a path of dialogue and reconciliation between newcomers and the host society as a way to foster true integration and understanding between immigrant and native communities.
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| 5. |
- Bogren, Malin, 1970, et al.
(författare)
-
Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia : A qualitative study
- 2020
-
Ingår i: Sexual and Reproductive Healthcare. - : Elsevier. - 1877-5756. ; 23
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveIn this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective.MethodsData were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia.ResultsVarious structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence.ConclusionsInequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.
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| 6. |
- Dahir, Gallad, et al.
(författare)
-
We have almost accepted child spacing. Let's wait on family planning and limiting children' : Focus group discussions among young people with tertiary education in Somalia
- 2023
-
Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 35
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.METHODS: A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.FINDINGS: The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.CONCLUSION: Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.
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| 7. |
- Dalmar, Abdirisak Ahmed, et al.
(författare)
-
Rebuilding research capacity in fragile states : the case of a Somali-Swedish global health initiative
- 2017
-
Ingår i: Global Health Action. - Abingdon : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.
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| 8. |
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| 9. |
- Durbeej, Natalie, et al.
(författare)
-
Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial) : study protocol for a cluster randomized controlled trial
- 2021
-
Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools.METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI).DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools.TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.
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| 10. |
- Durbeej, Natalie, et al.
(författare)
-
Evaluation of the Teaching Recovery Techniques intervention among newcomer students in Swedish schools : a randomised controlled trial turned into a feasibility study
- 2024
-
Ingår i: BMC Public Health. - 1471-2458. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During recent years, Europe has faced the arrival of migrants whereof a considerable group of youth present mental health problems, such as symptoms of post-traumatic stress disorder (PTSD). Schools offer a safe environment for mental health interventions to these groups, yet there is limited research on the impact of school-based interventions addressing mental health problems in newcomer youths, especially in the Swedish context. This cluster randomized controlled trial (RCT) aimed to explore the effectiveness of the Teaching Recovery Techniques (TRT) intervention among newcomer students with PTSD symptoms in Swedish secondary schools.METHODS: Nine schools were randomly assigned to TRT or a wait list control group prior to the baseline assessment. Follow-up data were collected immediately following the intervention and three months post-intervention. In total, 531 students were approached, of which 61 gave consent and were eligible to be included in the study: 55 in TRT and 6 in the control condition. Given the low number of participants in the control condition, we merely analyzed students who had received TRT.RESULTS: We report on feasibility of recruitment, data collection, intervention delivery and intervention effectiveness. In terms of intervention effectiveness, within subjects ANOVAs revealed significant reductions in PTSD symptoms and general mental health problems from baseline to the three months-follow-up (p < 0.001).CONCLUSIONS: Our results indicate that TRT is a promising school-based intervention for newcomer students with PTSD symptoms. For a successful implementation of TRT in the school context, schools need to be engaged and the implementation should be managed by a local coordinator.TRIAL REGISTRATION: ISRCTN, ISRCTN48178969, Retrospectively registered 20/12/2019.
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| 11. |
- Egal, Jama Ali, et al.
(författare)
-
A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs : a qualitative study among multiparous women in Somaliland
- 2022
-
Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women's choice of place of birth.OBJECTIVE: In this study, we explore multipara women's needs and preferences when choosing the place of birth.METHOD: An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years.RESULTS: The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth.CONCLUSION: To meet women's needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.
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| 12. |
- Egal, Jama Ali, 1977-, et al.
(författare)
-
Facility-based maternal deaths : Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland
- 2023
-
Ingår i: Sexual & Reproductive HealthCare. - 1877-5756 .- 1877-5764. ; 37
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
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| 13. |
- Egal, Jama Ali, 1977-, et al.
(författare)
-
Incidence and causes of severe maternal outcomes in Somaliland using the sub-Saharan Africa maternal near-miss criteria : A prospective cross-sectional study in a national referral hospital.
- 2022
-
Ingår i: International Journal of Gynecology & Obstetrics. - : Wiley. - 0020-7292 .- 1879-3479. ; 159:3, s. 856-864
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the incidence and causes of severe maternal outcomes and the unmet need for life-saving obstetric interventions among women admitted for delivery in a referral hospital in Somaliland.METHODS: A prospective cross-sectional study was conducted from April 15, 2019, to March 31, 2020, with women admitted during pregnancy or childbirth or within 42 days after delivery. Data was collected using the World Health Organization (WHO) and sub-Saharan Africa (SSA) maternal near-miss (MNM) tools. Descriptive analysis was performed by computing frequencies, proportions and ratios.RESULTS: The MNM ratio were 56 (SSA criteria) and 13 (WHO criteria) per 1,000 live births. The mortality index was highest among women with medical complications (63%), followed by obstetric haemorrhage (13%), pregnancy-related infection (10%) and hypertensive disorders (7.9%) according to the SSA MNM criteria. Most women giving birth received prophylactic oxytocin for postpartum haemorrhage prevention (97%), and most laparotomies (60%) for ruptured uterus were conducted after three hours.CONCLUSION: There is a need to improve the quality of maternal health services through implementation of evidence-based obstetric interventions and continuous in-service training for health care providers. Using the SSA MNM criteria could facilitate such preventive measures in this setting as well as similar low-resource contexts.
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| 14. |
- Egal, Jama Ali, 1977-
(författare)
-
Women search for normality in birth : Solutions empowering resilience and reproductive agency while reducing adverse outcomes for Somaliland women
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aimed to explore the causes of severe pregnancy outcomes and maternal deaths in Somaliland (studies I and II) and how these causes are influenced by the context of the wider health system (studies III and IV). Methodology: Both quantitative and qualitative methodologies were used. A prospective cross-sectional design was used to collect data for studies I and II. Study II focused on maternal deaths using a mixed method design. Studies III and IV used individual interviews to explore the needs of women when choosing a place of birth and the role of traditional birth attendants (TBAs) in maternity services in Somaliland. Analysis: Data were analysed using descriptive statistics and percentages. An inductive content analysis was used for study III, and a qualitative thematic analysis was used for study IV.Results: Study I showed that the maternal near-miss (MNM) ratio was 56 MNMs per 1,000 live births according to the Sub-Saharan Africa (SSA) criteria and 13 MNMs per 1,000 live births according to the WHO criteria. The mortality index was highest among women with medical complications. Study II highlighted that 89% of these women self-referred to the hospital and that only 25% were admitted to the intensive care unit. Poor risk awareness and inadequate interprofessional collaboration contributed to missed opportunities. Study III showed that the lack of reproductive agency involved in facility-based births makes home births a first choice, regardless of potential risks and medical needs. Study IV demonstrated that TBAs need to be better connected with health facilities and skilled birth attendants (SBAs) to reduce maternal and neonatal mortality and morbidities in Somaliland.Conclusion: Women search for normality in birth, and the midwifery profession could provide this normality by facilitating resilience and reproductive agency while reducing adverse outcomes of pregnancy, birth and the postpartum period. There is a need to improve the quality of maternal health services by implementing evidence-based obstetric interventions and continuous in-service training. The referral system needs to be strengthened by utilising TBAs as a community resource to support community maternal and child health centres.
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| 15. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
-
Evaluating a model for the capacity building of midwifery educators in Bangladesh through a blended, web-based master’s programme
- 2019
-
Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 12:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master’s programme in SRHR and the extent to which these were realized after 12 months of part-time study.Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses.Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students’ learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master’s programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students’ learning and how to foster reflective and critical thinking among them.Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.
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| 16. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
-
Evaluation of an online master’s programme in Somaliland : A phenomenographic study on the experience of professional and personal development among midwifery faculty
- 2017
-
Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 25, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.
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| 17. |
- Faysal Badal, Naciima, et al.
(författare)
-
With knowledge and support women can attend antenatal care : the views of women in IDP camps in Somaliland
- 2018
-
Ingår i: African Journal of Midwifery and Womens' Health. - : Mark Allen Group. - 1759-7374 .- 2052-4293. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”. The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.
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| 18. |
- Kalid, Mohamed, et al.
(författare)
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Dietary diversity and associated factors among households and children in internally displaced person camps in Southern Somalia : A cross-sectional study
- 2024
-
Ingår i: Maternal and Child Nutrition. - 1740-8695 .- 1740-8709.
-
Tidskriftsartikel (refereegranskat)abstract
- The study aimed to assess household and child dietary diversity in Southern Somalia by identifying determinants of adequate dietary diversity in three internally displaced person (IDP) camps in Baidoa, Dayniile and Dharkanley. A total of 1655 female main caregivers with 2370 children (6-59 months old) were included. Data on household dietary diversity score and child dietary diversity score indicators were collected from all households. The questionnaire was read face-to-face to the female main caregivers. Multivariate logistic regression analysis was performed to identify factors associated with adequate dietary diversity, which was defined as the consumption of at least four food groups within 24 h before the survey. The proportion of households achieving adequate HDDS was high in all locations 95.8%, 96.9% and 89.0% in Baidoa, Dharkanley and Dayniile, respectively, and the total adequate household dietary diversity score (AHDDS) was 95.6%. The proportion of adequate child dietary diversity score (ACDDS) was achieved in 63.5%, 8.5% and 38.3%. The main factors associated with AHDDS were larger household size, greater wealth, attendance of antenatal care (ANC) and joint decision-making between husband and wife, while factors associated with ACDDS included ANC attendance, age, the consumption of ready-to-use therapeutic food and deworming tablets. These findings can guide future programmes and policies aimed at improving maternal and child nutrition in IDP camps in Somalia. By tackling these diverse factors, a promising pathway emerges to enhance the nutritional welfare of both households and children in IDP camps.
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| 19. |
- Kalid, Mohamed, et al.
(författare)
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Effects of Nutrition Counselling and Unconditional Cash Transfer on Child Growth and Family Food Security in Internally Displaced Person Camps in Somalia : A Quasi-Experimental Study
- 2022
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:20
-
Tidskriftsartikel (refereegranskat)abstract
- The effects of nutrition counselling (NC) and unconditional cash transfer (UCT) in improving growth in children under five and household food security are poorly understood in humanitarian settings. Therefore, this study aimed to evaluate the effects of NC and NC combined with unconditional cash transfer (NC + UCT) on children’s growth and food security in Somalia. The study was performed with a quasi-experimental design in two districts in the Banadir region of Somalia. Caregivers (n = 255) with mildly to moderately malnourished children aged 6 to 59 months old (n = 184) were randomized to the NC, NC + UCT and control groups. The interventions consisted of weekly NC for three months alone or in combination with UCT. The outcome variables were wasting, underweight, stunting, and food security. Difference-indifferences analysis was used to estimate the effect of the interventions. Our study did not find any significant impacts of NC or NC + UCT on child wasting, underweight, stunting, food security or household expenses. In conclusion, NC, alone or in combination with UCT, did not impact children’s growth or household food security. Thus, a culturally tailored NC programme over a longer period, supplemented with cash transfer, could be beneficial to consider when designing interventions to reduce malnutrition and food insecurity.
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| 20. |
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| 21. |
- Kankaanpää, Reeta, et al.
(författare)
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Psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia
- 2024
-
Ingår i: European Journal of Psychotraumatology. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children’s Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717−.856), whereas it was higher among Somali adolescents (.831−.887). The total score had medium-sized correlations with emotional problems (.303−.418) and low correlations with hyperactivity (.077−.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.
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| 22. |
- Kiruja, Jonah, et al.
(författare)
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Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context : a cohort study in a national referral hospital
- 2023
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. Objective To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored. Methods Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Results Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). Conclusions In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.
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| 23. |
- Kiruja, Jonah, et al.
(författare)
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Healthcare providers' experiences of comprehensive emergency obstetric care in Somaliland : An explorative study with focus on cesarean deliveries
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in SomalilandMethods: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.Results: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.Conclusions: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.
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| 24. |
- Kiruja, J., et al.
(författare)
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Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland : A pilot study using the WHO near-miss approach
- 2017
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 12, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.
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| 25. |
- Kiruja, Jonah
(författare)
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Quality of maternal healthcare : Exploring severe maternal outcomes and the influence of delays and decision-making on caesarean sections in a low-resource setting
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Somaliland has one of the highest maternal mortality rates worldwide, yet there is limited evidence for severe maternal outcomes and challenges with the provision and utilisation of emergency obstetric care (EmOC). This thesis studied quality of maternal healthcare by exploring severe maternal outcomes and the influences of delays and decision-making on caesarean sections in Somaliland.In Paper I, incidences of severe maternal outcomes and unmet need for emergency obstetric care interventions were investigated at the national hospital using a cross sectional study. The maternal mortality ratio was 462 per 100,000 live births and the maternal near miss ratio 56.5 per 1000 live births, according to sub-Saharan Africa criteria. Most laparotomies (60%) were performed after more than 3 hours. Medical complications (63%) had the highest mortality index.In Paper II, an explorative qualitative study using focus group discussions was conducted with healthcare providers. A collective decision-making process at the family rather than individual level by the woman; poverty and lack of awareness; and healthcare system factors such as miscommunication, infrastructure and inadequate collaboration were experienced as factors contributing to delays with the utilisation of EmOC.In Paper III, a cohort study examined whether there was an association between delayed caesarean section (CS) and adverse maternal and newborn outcomes and the type of barrier leading to delayed CS. A delay in CS of more than 3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, (95% CI [1.13–2.21]). Moreover, family decision-making for consent was the most important barrier leading to delays of more than 3 hours (48%). In Paper IV, a mixed methods study was conducted to investigate barriers to and facilitators of timely family consent for CS. Women with hypertensive disorders (aOR 8.491, 95% [1.076–66.991]) and obstetric hemorrhage (aOR 3.209, 95% CI [1.159–8.887]) were likely to have late family consent for CS. Poor communication and understanding, differences in understanding between family members on the need for CS and absence of the person giving consent were barriers to timely family consent for CS to be performed. Husband’s autonomous decision-making for CS, adequate disclosure of all relevant information about CS and previous CS aided timely family consent for CS performance.There is need to improve the overall quality of maternal healthcare to reduce severe maternal outcomes. A proactive-orientated model is suggested with strategies targeting the community and healthcare system including training of healthcare providers on intracultural communication competence, obtaining consent and using associated protocols and guidelines, interprofessional collaboration and the use of alternative birth methods other than CS. Antenatal care should be used to prepare families for potential obstetric emergencies and obtain written informed consent. Moreover, women should be allowed to give consent in maternal health emergencies.
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